Temporal Augmentation after Craniectomy

Q: Dr. Eppley, I am researching for my 20 year old son. He had a large craniectomy done two years ago and the replacement was a plastic implant. They were not able to reattach his temporal muscles and it has left a bump at his temporal area above his ear and a drooping eyelid. Can this be fixed? Can the muscle be reattached? What are the future complications? Thank you for your help.

A: Thank you for your inquiry and sending his pictures. What your son has is a temporal muscle retraction which has no functional implications. It can not now be unraveled and lifted back up and repositioned due to muscle atrophy and scarring. To treat the contour defect my approach is to build up the temporal area with hydroxyapatite cement (temporal augmnentation) to replace the bulk that was once there from the muscle. This can be done through his existing scalp incision.

The drooping eyelid is a facial nerve issue for which there is restoration of the motor nerve function that was lost. That is treated like ptosis repair to lift up the eyelid to a better level to the upper rim of the iris of the eye.

Dr. Barry Eppley
Indianapolis, Indiana